Surgical Techniques
Tibial Tubercle Screw Fixation on Custom Metaphyseal Cone: Surgical Tip in Severe Metaphyseal Tibia Bone Loss
Tibial tubercle osteotomy (TTO) facilitates exposure in knee arthroplasty revision. However, it comes with complications, especially if it invades the intramedullary canal. Most revisions are characterized by compromised femur and/or tibia bone stock, and the use of metaphyseal cones or sleeves for implant fixation has become increasingly frequent. Several methods of fixation of the tibial tubercle have been proposed, such as screw fixation, cerclage wiring, and suture repair. Despite screws providing the strongest fixation for TTO, their placement around a tibial intramedullary stem or a metaphyseal tibial cone may be difficult.Single-Sided Reciprocating Saw for Tibial Component Removal During Revision Total Knee Arthroplasty
Revision total knee arthroplasty often necessitates removing well-fixed components. Tibial tray removal is challenging becaue of 1) physical barriers posed by the component pegs, keel, or stem in accessing the implant-bone interface circumferentially and 2) proximity of vulnerable structures including the patellar tendon, collateral ligaments, popliteal artery, and distal femur. In this report, we present a step-by-step technique for removal of a well-fixed tibial component using a single-sided reciprocating saw.A Simple, Personalized Opioid Stratification Pathway Dramatically Reduces Opioid Utilization
Orthopaedic surgeons account for the largest proportion of opioid prescriptions in the United States among surgical specialties. In total joint arthroplasty, increased opioid use has been associated with poorer clinical and functional outcomes. Despite an abundance of literature on opioid mitigation strategies, most fail to provide personalized prescriptions. Typically, most protocols prescribe the same opioid regimen regardless of patient factors or the extent of the planned procedure. We present a simple opioid stratification pathway that can be used by physicians and office staff as they prepare patients for arthroplasty.Total knee arthroplasty in patients with multiple hereditary exostoses
We present a case report of a patient with severe valgus deformity of the right knee due to multiple hereditary exostoses (MHEs) treated with total knee arthroplasty (TKA). The surgical management of MHE affecting the knee encompasses exostoses resection, joint deformity rectification, and limb-length discrepancy alignment. On rare occasions, distraction osteogenesis and TKA have been used to correct valgus deformities of the knee. TKA in MHE patients with knee involvement has only been described in 6 cases.
